We’ve been arguing for months (or is it years?) about what health insurance through the Covered California exchange — our local flavor of Obamacare — will cost. Now we know. It’s at the link just below.

Obamacare essentially eliminates most of that highly lousy individual insurance we’ve enjoyed for years and replaces it with group insurance — and the discounts obtained from it — by putting almost all of the otherwise uninsured into a group. (That’s in addition to all of the consumer protection provisions — ending rescission and pre-existing condition exclusions and annual and lifetime limits and more — that liberals love and conservatives are generally afraid to criticize out loud.) The argument has been made here — loudly and often — that this insurance will be too expensive for people to afford.

Well, using this calculator, now we can discuss this in concrete terms. All are in OC Region 18. Meet me below the photo of a smiling and triumphant Health and Human Services Secretary Kathleen Sebelius.

You cannot stop Kathleen Sebelius when she wants to implement Obamacare. You might as well not even try.

Example 1: Married couple, 32 and 29, with 3 kids making $50,100/year, in Santa Ana

OK, you can see the assumptions I’m making above. Let’s see what their insurance will cost. Here’s what it says:

Metal Tiers: Enhanced Silver 87, and Bronze

The two options displayed below detail the options that are the lowest cost and best value for you. You can compare the benefits provided at each plan level or “metal tier.”

The two best options for you are the Enhanced Silver 87 or the Bronze plans.

Due to your income level, you qualify for the Enhanced Silver 87 plans, which provide assistance with out-of-pocket costs in addition to premium assistance. Enhanced Silver 87 plans will cover an average of 87% of costs, meaning that, on average, you will be responsible for 13% of your health care costs. Most common covered services under the Enhanced Silver Plan do not have a deductible.

You could also select a Bronze plan. Bronze plans cover an average of 60% of costs, meaning that, on average, you will be responsible for paying 40% of your health care costs. Also, most services covered by the Bronze plan are subject to a deductible, or amount you must pay out-of-pocket before the plan will cover costs.

You can compare the charts below to see what your costs would be under each plan. It is important to understand the benefits and risks, and determine how much health care you expect to use. While the Bronze plan has the cheapest monthly premium, the Enhanced Silver Plan provides a lower risk of out-of-pocket costs, making it a better value for most people.

STANDARD BENEFITS FOR INDIVIDUALS

Key benefits

Bronze 60 (italics) andEnhanced Silver 87 (underlined)

(You’ll need to see the chart to see what’s subject to the deductible: most of bronze and little of silver)

This family will be subsidized $292/month (a tax credit) for their health insurance.

Anthem Blue Cross is offering two Bronze plans, one that will cost this family $100/month and one $103/mo. HealthNet has a Bronze plan for $132/mo; Blue Shield for $137/mo.

HealthNet’s Silver plan is $166/month. Anthem Blue Cross has one for $228 and one for $232 and Blue Shield’s is $236.

Let’s try another one.

Example 2: Married couple, 58 and 57, with 0 kids, making $150,100/year, in Newport Beach

Here’s what it spits out for them.

Metal Tiers: Platinum, Gold, Silver, and Bronze

You do not qualify for premium assistance through Covered California. However, you may still purchase a high quality health insurance plan that fits your needs. Each private health insurance plan sold through Covered California offers four different levels of coverage. These levels, or “metal tiers,” are called platinum, gold, silver, and bronze.

Platinum plans have the highest premium, yet pay 90% of covered health care expenses. Bronze plans have the lowest premium, but pay only 60% of covered health expenses. It’s important to think about how much health care you will need when choosing a level. The charts below show how much you will pay for covered services under each level of plan.

This family will not be subsidized for their health insurance. These next figures may seem high — but compared to the pre-Obamacare cost of non-group health insurance (leaving aside pre-existing conditions and the like) for a couple this age, they aren’t. For whatever reason, Kaiser HMO doesn’t seem to be available to them. (To find Kaiser, you have to notice that there are two dots on the bottom of the list of plans and realize that you have to click on the second one. Bad page design there!)

The Bronze PPO plans would cost this family between $848 and $929 per month, or $945-960 for Kaiser HMO.

The Silver PPO plans would cost this family between $992 and $1143 per month, or $1306 for Kaiser.

The Gold PPO plans would cost this family between $1142 and $1408 per month, or $1588 for Kaiser.

The Platinum PPO plans would cost this family between $1266 and $1609 per month, or $1708 for Kaiser.

If any older couples in this (or a similar) income range want to share how much they’re currently paying for non-group insurance, I’d be interested in knowing.

The Bronze PPO plans would cost this individual between $178 and $198 per month, or $202-205 for Kaiser HMO.

The Silver PPO plans would cost this individual between $209 and $240 per month, or $275 for Kaiser.

The Gold PPO plans would cost this individual between $236 and $298 per month, with $335 for Kaiser, though Kaiser and the most expensive plan are “grayed out” for some unexplained reason.

The Platinum PPO plans would cost this individual $266 per month for HealthNet, between $324 and $338 for three “grayed out” plans, and $359 for Kaiser. (Maybe the grayed-out plans are just worse deals?)

So, at the low level, about $3000 per month gross income, for a Silver plan $200 goes to insurance. This is without subsidies; for someone making less income, it would be less.

Any other calculations you’d like to add for yourselves?

A Final Note:

This is what you get when you want to work through private insurers, without cost competition from a public option. A single-payer plan would probably be cheaper and easier in the long-run, but then people wouldn’t be as desperate! (Can’t have that!)

About Greg Diamond

Somewhat verbose worker's rights and government accountability attorney, residing in northwest Brea. General Counsel of CATER, the Coalition of Anaheim Taxpayers for Economic Responsibility, a non-partisan group of people sick of local corruption.
Deposed as Northern Vice Chair of DPOC in April 2014 when his anti-corruption and pro-consumer work in Anaheim infuriated the Building Trades and Teamsters in spring 2014, who then worked with the lawless and power-mad DPOC Chair to eliminate his internal oversight.
Occasionally runs for office to challenge some nasty incumbent who would otherwise run unopposed. (Someday he might pick a fight with the intent to win rather than just dent someone. You'll know it when you see it.) He got 45% of the vote against Bob Huff for State Senate in 2012 and in 2014 became the first attorney to challenge OCDA Tony Rackauckas since 2002.
None of his pre-putsch writings ever spoke for the Democratic Party at the local, county, state, national, or galactic level, nor do they now.
A family member co-owns a business offering campaign treasurer services to Democratic candidates and the odd independent. He is very proud of her. He doesn't directly profit from her work and it doesn't affect his coverage. (He does not always favor her clients, though she might hesitate to take one that he truly hated.)
He does advise some local campaigns informally and (so far) without compensation. (If that last bit changes, he will declare the interest.)

from what I understand… $5,000 deductible…insurance does not pay until that is met…meaning you better have the money for tests. medications, doctor visits…”no money-no honey. Why are their tier plans? Why aren’t we all treated the same? If the plan is so great, why are government reps and their staff exempt?

The wealthy get Bronze… the poor get Silver.

I doubt it is as transparent as that… I read pre-existing will be covered but only after being on plan for one year. What will one do for the months before? From past experience the realty is always different than what we are told.

If Kaiser is my option… I will take the penalty. Kaiser = DEATH if one has cancer. I watched (so far) 4 people die because of incompetent care by Kaiser. 2 others who were smart enough to get 2nd opinion survived cancer and are cancer free. (Kaiser told them hospice was only option)

We could afford single payer (Medicare) for everyone if our “representatives” STOPPED sending OUR tax dollars to support other countries….

Wish I was as optimistic as Greg…but past experience tells me otherwise.

Most of the services for Silver are not subject to the deductible. (I left that info out because it involved doing a lot of color-coding and this was complicated enough as it is.) The Bronze plan has lots of deductibles; it’s more like catastrophic-only insurance (but not entirely.) The small price difference between Silver and Bronze means that pretty much everyone should get Silver or above.

I think it is subject to change before the deadline. I will wait until the end of the year, when people get the real numbers. There are always hidden exceptions that one won’t discover until one needs them.

Are you comfortable giving out all your private information to someone over the internet or phone and then getting your premiums deducted monthly form your checking account? Sure, they will have background checks. So what. I am helping someone with an identity theft case now…what a nightmare. Law enforcement doesn’t care… too many to deal with these days… they take a report and shove it in a file.

I think that the “real numbers” are due, by law, this October 1. I don’t know why they’re giving us this sneak peek — except that, if they’re ready, why not?

No, I’m not “comfortable” with the payroll deductions, but I do it in other places — and I give out lots of personal information to my wife’s employer, to my landlord, and to other creditors. It’s part of getting insurance as it is even pre-Obamacare.

The small insult that this does to my privacy seems dwarfed by what can happen through NSA and such. The only time I can recall getting ripped off in the past few years was when my wife’s credit card was stolen by a restaurant cashier. My question is: is this program offering people reasonable value for their money.

The 30% is the ‘CO-INSURANCE’ portion that you are responsible for, as the carrier picks up the other 70%.

Because you would be in-network, the provider cuts you a break by reducing the full cost of their services.
That reduction is the negotiated rate that the carriers set forth.
Raw rate – Negotiated discount = negotiated rate x co-insurance (30%) = your cost.

Let’s use an example:
Let’s say Bob has no insurance and his office visit to the doctor would be $500

But you have insurance and because of that, there is a discount (or negotiated rate) so that same visit would be $300, not the $500 rate for not having insurance.

So your 30% of the pre-negotiated rate of $300, would be $90 for that visit.